第二軍醫(yī)大學(xué)長征醫(yī)院骨科DepartmentofOrthopaedicSurgery,ChangzhengHospital,Shanghai

侯春林HOUChun-lin

帶血管蒂組織瓣移位術(shù)解剖與基本原則Anatomyofvascularpedicleflapsandprincipleoftheoperation

帶血管組織瓣移位術(shù)是以組織瓣的營養(yǎng)血管為蒂，通過局部轉(zhuǎn)移來修復(fù)臨近組織缺損。Thetransferofcutaneous,myocutaneousandmuscleflapswithvascularpedicleisasurgicalskilltoreconstructadjacenttissuedefect.Thepedicelsoftheseflapsaretheirnutritionalbloodvessels.

前言foreword由于幾乎全身所有部位皮膚均可形成皮瓣、肌皮瓣，這就使全身任何部位創(chuàng)面均可采用帶血管蒂組織瓣移位術(shù)治療。Theflapcanbeacquiredfromeveryanatomicregionofthebody.Sothismakealldefectscanbereconstructedbytransferringofvascularpedicleflaps.前言foreword與吻合血管的游離組織移植相比，此項技術(shù)不需吻合血管，方法簡便、安全、成功率高，現(xiàn)已用于外科各個領(lǐng)域。Contrastingwithdissociativetissueflaps,itisnotrequiredtoconnectvesselsbyanastomosisintransferofflapswithvascularpedicle.Thistechnicissimpleandsafe.Ithasbeingappliedineverysurgicalfield.前言foreword帶血管蒂的皮瓣、?。ㄆぃ┌贽D(zhuǎn)移術(shù)是把帶有血管蒂的皮瓣、肌（皮）瓣，通過局部轉(zhuǎn)移的方法，來修復(fù)鄰近組織缺損Thetransferofcutaneous,myocutaneousandmuscleflapswithvascularpedicleisasurgicalskilltoreconstructadjacenttissuedefectbylocaldisplacement.Bloodsupplyofskin直接皮動脈

directcutaneousartery肌皮動脈musculocutaneousarteryBloodsupplyofmuscleBloodsupplyofmuscleBloodsupplyoffasciaprofunda筋膜上血管叢Vascularplexusup-fascia筋膜下血管叢Vascularplexussub-fascia筋膜Fascia皮膚Skin肌肉Muscle肌皮穿支動脈Ramusofmusculocutaneousartery肌間隙血管Vesselbetweenmuscles皮瓣類型

Classificationofskinflaps

隨意皮瓣

Randomflap

筋膜皮瓣與筋膜瓣

Fasciocutaneousflapandfasciaflap

軸形皮瓣

Axialflap

肌皮瓣與肌瓣

musculocutaneousflapandmuscleflap筋膜皮瓣

Fasciocutaneousflap筋膜皮瓣

Fasciocutaneousflap皮膚Skin皮下組織Subcutaneustissue肌肉muscle深筋膜fasciaprofunda筋膜皮瓣Fasciocutaneousflap翻轉(zhuǎn)筋膜瓣Reversalfasciocutaneousflap軸型皮瓣Axialflap軸型皮瓣Axialflap肌間隙血管Vesselbetweenmuscles皮膚Skin皮下組織Subcutaneustissue深筋膜fasciaprofunda肌肉muscle軸型皮瓣

Axialflap肌皮瓣Musculocutaneousflap肌肉皮膚蒂肌皮瓣Musculocutaneousflapwithmusculocutaneouspedicle肌肉皮下組織蒂肌皮瓣Musculocutaneousflapwithmusculosubcutaneouspedicle肌肉蒂肌皮瓣

Musculocutaneousflapwithmusclepedicle

血管神經(jīng)蒂島狀肌皮瓣Musculocutaneousislandflapwithvasonervalpedicle肌皮瓣musculocutaneousflap皮瓣設(shè)計Designoftheflap

點旋轉(zhuǎn)軸Point－axistotransferflaps

線軸心線Line－axallineoftheflap面血供范圍Range－extenttowhichthenutritionalvesselcansupply弧旋轉(zhuǎn)弧

Arc－boundarythattheflapcanreachAxisandarcofflap創(chuàng)傷、潰瘍、腫瘤切除所致軟組織缺損

Softtissuedefectofanycausesthatcouldnotbereconstructedthroughconventionalmethods四肢瘢痕攣縮畸形，切除瘢痕、矯正畸形有深部組織裸露

Malformationcausedbyscarcrispation,baredeeptissuescausedbyscarexcisionandmalformationrectification手術(shù)指征

Indication需在瘢痕或竇道區(qū)進行骨、關(guān)節(jié)、肌腱手術(shù)者

Operationsonbone,jointortendonsinregionsofscarsandsinuses慢性骨髓炎病灶清除后有創(chuàng)面裸露

CavitiesofSuperciliousulcer,purulent

osteomyelitisandbedsorethatneedtobecleanedupinphade1afterthoroughtreatment.感覺、運動功能重建及某些器官再造

Woundsrepairwithsimultaneousreconstructionofmotorornervefunction.手術(shù)指征

Indication對供區(qū)功能、外觀影響較小

Theflapwithlessaffecttodonorsite.血管恒定、變異少，易于切取

Theflapacquiredeasilyandwithlessvariable

vessles

根據(jù)受區(qū)部位、大小、創(chuàng)面性質(zhì)及功能要求選擇皮瓣

Theflapsuitforrecipientsiteinposition,size,

qualityandfunction.皮瓣選擇Selectionofflap鄰近創(chuàng)面的皮瓣，質(zhì)地近似，轉(zhuǎn)移方便，應(yīng)優(yōu)先選用

Thepreferableflapwiththecharacterofadjacenttotherecipientsite,havingsimilartextureandthicknessandeasilytransferred根據(jù)受區(qū)部位選擇皮瓣Selectionofflapaccordingtorecipientsite足底皮瓣P(guān)lantarflapoffoot

足背皮瓣Dorsalflapoffoot小腿皮瓣Cruralflap足跟創(chuàng)面calcanealdefect無骨和肌肉缺損的創(chuàng)面，選用軸型皮瓣

Theaxialflap——suitableforwoundwithoutdefectofboneandmuscle有骨或肌肉缺損的創(chuàng)面選用肌皮瓣較好

Themusculocutaneousflap——suitableforwoundwithdefectofboneandmuscle根據(jù)創(chuàng)面性質(zhì)選擇皮瓣Selectionofflapaccordingtodefectcharacter

需同時恢復(fù)缺損區(qū)感覺功能時，應(yīng)選用含感覺神經(jīng)的皮瓣；需同時重建缺損區(qū)肌肉功能時，應(yīng)選用帶運動神經(jīng)的肌皮瓣。

Ifthefunctionofmovementorsenseisrequired,theflapshouldbecomposedwiththemuscleorsensenerve.根據(jù)受區(qū)功能要求選擇皮瓣SelectionofflapaccordingtofunctionrequirementofrecipientsiteN.DigitalesdorsalesN.DigitalespalmarespropriiA.Digitalespalmaresproprii根據(jù)創(chuàng)面大小選擇皮瓣Selectionofflapaccordingtothesizeofdefect皮瓣選擇應(yīng)考慮到受區(qū)范圍及皮瓣可能提供的大小，皮瓣應(yīng)稍大于受區(qū)創(chuàng)面Thesizeofdefectandflapshouldbeconsidered.Thesizeofflapshouldexceedthatofthedefect.手術(shù)要點

Operationoutline慢性感染創(chuàng)面需徹底病灶清除

Thesinus,deadbone,inflammatorytissuewithpoorbloodsupplymustbethoroughlycleanedup.受區(qū)準備Preparationoftherecipientsite

先標明旋轉(zhuǎn)中心位置及皮瓣縱軸線，根據(jù)創(chuàng)面形狀及大小設(shè)計皮瓣

First,makesurethepositionofthevascularpedicleandthenutritionalvesseloftheflap,thenmarkitontheskin.Designtheflapaccordingtotheshapeandsizeofthedefect.皮瓣設(shè)計Designoftheflapadobc上部臀大肌肌皮瓣修復(fù)骶部褥瘡RepairthesacrumbedsoreusingthemyocutaneoussuperiorofMusclegluteusmaximus順行切取

先顯露血管蒂部,由近向遠分離皮瓣

First,exposet